1. Exploring Factors Associated with Compliance with CKD-specific Low Protein Supplements among CKD Patients
Registered Dietitian, FANG-CHING HU

2. Vegetarian Meals in Tzu Chi Hospital
Feature fresh, locally grown vegetables
At least 1 portion of leafy green vegetable per meal
At least 2 other colored vegetables per meal
Options of grain choices: white rice, brown rice, multi-grain rice, noodles, congee, Chinese buns (“Mantou”) 2

3. Soy bean curd with red and yellow pepper in tomato sauce Tofu wrapped
in veggie ham
Stir-fry bok choy and carrots
Stir-fry spinach
Fresh melon
Tofu and bean sprout soup
Rice with black sesame 3

4. Stir fry “Chinese Watercress” Vegan “fish” stake Scramble eggs
Bean sprouts & carrot threads
Vegetable soup
Fresh Guava
Multi-grain rice 4

5. Breakfast Lunch Dinner
Meal
Snack 5

6. Vegetarian Food Court for patients, families, visitors and staff
vegan cafeteria with 100+dishes
Hot Pots
Noodle Shop
Traditional Taiwanese food
Japanese Style
Korean Style
And more … 6

7. Vegetarian Food Court 7

8. 8

9. Vegetarian Food Court 9

10. For our CKD outpatient, we want to do more!10

11. Protein energy wasting (PEW)11
Kidney International (2013) 84, 1096–1107

12. Taiwan CKD 12
Lancet 2008; 371: 2173–82

13. Taiwan CKD 13
Lancet 2008; 371: 2173–82

14. Prevalence of ESRD

15. Incidence of ESRD 15

16. Taiwan strategies Publish “the uncomfortable truth”
TSN & BNHI & NHI work together
Aristolochic acid Prohibition
Intensive care program
Pre ESRD
Early CKD
Multidisciplinary care 16

17. Pre-ESRD care program Nephrologists, nephrology nurse and dietitian
Medical management
Lifestyle modification
Regularly follow up (Lab data)

18. The facts are…
Patients on low protein diets often have difficulty to meet nutritional requirements.
They have to use CKD-specific low protein supplements every day. 18

19. Low protein supplements
425 kcal/can
10.6 g protein
242 kcal/bag
3.9 g protein
200 kcal/bag
0.6 g protein

20. Taiwanese traditional low protein materials
Corn starch
Sweet potato starch
Tapioca
Flat noodle
Sago
Grass jelly
0.02 g protein per serving
0.02 g protein per serving 20

21. Taiwanese traditional low protein food
Pyramid dumplings
Bowl rice cake
0.04 g protein per serving
Rice noodle
Ba wan
0.1 g protein per serving 21

22. Taiwanese traditional low protein food
Sago
0.02 g protein per serving
0.08 g protein per 100 g
Fen yuan
Bubble Tea 22

23. We want to know… There are various low protein supplements options
Compliance of CKD-specific supplements
Effect of current education 23

24. Objective
This study investigated Taipei Tzu Chi Hospital CKD outpatients’ compliance with CKD-specific low protein supplement and determined the factors which associated with the compliance. 24

25. Methods 25

26. Methods Patients in pre-ESRD care program with stage 3~5
Among 1053 CKD patients, 477 were recommended on CKD-specific low protein supplement daily
A telephone interview (check 477 patients for the low protein supplement use)
Analyze the reasons for the noncomplier 26

27. Results 27

28. Table 1. Reasons for not using CKD-specific low protein supplements
No. (%) (n=125)
Patients had unclear with the concepts.
(ex. Patients did not know the importance of eating supplements or ate the wrong supplements)
81 (64.8%)
Patients were affected by their families or lived alone.
26 (20.8%)
Patient dissatisfied with texture and taste.
6 (4.8%)
Preparing meals were inconvenience for patients.
4 (3.2%)
Patients forgot to eat supplements.
2 (1.6%)
Patients had side effects after eating supplements.
Patients had no appetite recently.
Patients had financial problem. 28

29. CKD stage of noncomplier (n=125)
15.2%
30.4%
54.4%
Age of noncomplier (n=125)
31.2%
68.8% 29

30. Think about it…
Family support
Education models 30

31. 們診 31

32. Conclusion Renal protection
Reversible causes, ACEI/ARB, Bicarbonate, Lipid, Anemia…
Taiwan strategies
Multidisciplinary care, Aristolochic acid prohibition
Nutritional therapy
Low protein diet, provide CKD-specific low protein supplement education services to CKD patients along with their families to clarify patients’ concepts and seek for better family support 32

33. THANKS FOR YOUR ATTENTION!!33